Complex Regional Pain Syndrome (CRPS)
Complex regional pain syndrome (CRPS) is a broad term describing excess and prolonged pain and inflammation that follows an injury (more commonly fracture), typically to an arm or leg. CRPS has acute and chronic forms.
What does it feel like?
- Continuous burning or throbbing pain, usually in the arm, leg, hand or foot
- Sensitivity to touch or cold
- Swelling of the painful area
- Changes in skin temperature – alternating between sweaty and cold
- Changes in skin colour, ranging from white and blotchy to red or blue
- Changes in skin texture, which may become tender, thin or shiny in the affected area
- Changes in hair and nail growth
- Joint stiffness, swelling and damage
- Muscle spasms, tremors and weakness (atrophy)
- Decreased ability to move the affected body part.
Symptoms may change over time and vary from person to person. Symptoms can resolve on their own, but may persist for months to years. Overtime, the affected limb can become cold and pale. It may undergo skin and nail changes as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible.
Females are three times more likely to be affected than males.
What causes CRPS?
The cause is not completely understood. It’s thought to be caused by an injury to, or difference in, the peripheral and central nervous systems. CRPS typically occurs as a result of trauma or an injury.
CRPS occurs in two types (similar signs and symptoms but different causes):
- TYPE 1 – also known as reflex sympathetic dystrophy (RSD), this type occurs after an illness or injury that didn’t directly damage the nerves in the affected limb. About 90%.
- TYPE 2 – once referred to a causalgia, this type has symptoms similar to those of type 1, but type 2 CRPS occurs after a distinct nerve injury.
Many causes occur after forceful trauma resulting in a crushing injury or a fracture. Other major and minor traumas – such as surgery, heart attacks, infections and even sprained ankles – can also lead to CRPS.
How can it be diagnosed?
Diagnosis is based on a physical exam and the patient’s medical history. There’s no single test that can definitively diagnose CRPS, but the following procedures may provide important clues:
- Bone scan
- Sweat production tests
- X-rays
- MRI
How is CRPS treated?
There is no single treatment that is used to manage or resolve CRPS, rather it is dependent on the patient, their symptoms and their medical history. Below is a list of treatment modalities for CRPS, although the list is not exhaustive.
Therapies
- Heat therapy – relief of swelling and discomfort on skin that feels cold
- Physical or occupational therapy – gentle, guided exercise of the affected limb, or modifying daily activities might help decrease pain and improve range of motion and strength. The earlier the diagnosis, the more effective exercises might be
- Mirror therapy – sitting before a mirror or mirror box, the patient will move the healthy limb so that the brain perceives it as the limb that is affected by CRPS
- Transcutaneous electrical nerve stimulation (TENS) – chronic pain relieved by electrical impulses
- Biofeedback – learning to become more aware of your body so that you can relax your body and relieve pain
- Spinal cord stimulation – tiny electrodes inserted along the spinal cord. A small electrical current is delivered to the spinal cord, resulting in pain relief
- Acupuncture – stimulate nerves, increase blood flow and relieve pain.
Medications:
- Pain relief – either over-the-counter or prescription
- Anti-depressants and anti-convulsants – treating neuropathic pain
- Corticosteroids – reduce inflammation and provide mobility in the affected limb
- Bone-loss medications – to prevent and stall bone loss
- Sympathetic nerve-blocking medication – pain relief
- Medicines to lower blood pressure – pain management.
Conclusion
Complex regional pain syndrome is an uncommon condition whereby prolonged inflammation and pain is experienced following an injury (more commonly a fracture), typically to an arm or leg. Although CRPS improves over time, eventually going away in most people, the severe or prolonged cases are profoundly disabling. Because of the varied symptoms, the fact that symptoms may change over time, and the difficulty finding a positive cause in some cases, CRPS is hard to treat. There is no treatment that rapidly cures CRPS.
It is important to address symptoms early to reduce pain and discomfort and improve function. If you are experiencing pain, swelling, redness, temperature changes when compared to contralateral limb and hypersensitivity, it is important to see a podiatrist for a proper evaluation and treatment plan.
